Bend Lifetime Leaders Program Application
Thank you for your interest in the first cohort of the Bend Lifetime Leaders program. In order for your application to be considered, it must be completed in full and submitted by Wednesday, May 1. If you have any questions, please contact Talena at 541-382-3221 or email

The Lifetime Leaders Program is for those who have a lifetime of accumulated skills and leadership, and seek to share their wealth of experience to improve their communities and their lives.

Applicants must meet all of the following criteria:
• Have a demonstrable connection to Bend and Central Oregon
• Show evidence of tangible active leadership in the workplace and/or in the community
• Be willing to commit the required time to the Lifetime Leaders Program
• Be committed to employing leadership skills and knowledge for the long-term benefit of the community

Name *
First and last name
Street Address *
City *
State *
Zip Code *
Email *
Preferred Phone Number *
How did you hear about the Bend Lifetime Leaders Program?
We're interested in your past work and educational experience. Please attach a copy of your resume or bio (no more than two pages). Note: If unable to upload, please email to
What is your connection to Bend/Central Oregon? *
How long have you lived/did you work in the area? *
Please describe your connection to the community (personal and/or professional) and any preparatory steps you have taken to engage in local issues. If you are new to Bend, please describe the above as it relates to your prior home. *
How do you anticipate that the Bend Lifetime Leadership will help you to broaden and strengthen your impact in the region? Where do you want your community leadership journey to take you? *
We would like to know about your leadership journey to date. Please give examples of professional and community leadership experience. *
Why is the Bend Lifetime Leaders program a good fit for you at this time? *
Community Service Information - please list any community service you have been involved with outside of your employment. Include the organization name, the dates of service, and the type of service performed. (i.e. board service, committee involvement, etc...) *
What else would you like the Selection Committee to take into account when reviewing your application? (suggestions: personal story, passion, critical life experience, hobbies, goals, or personal mission statement)
Thank you for your interest in the Bend Lifetime Leaders Program! We will contact you in early May.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service